FOCUS Triage

About

Focus Triage tests if family dyads randomly assigned to either a brief or extensive family-based program of care (FOCUS Program) have better patient and caregiver outcomes than dyads randomly assigned to usual care. Outcomes being studied: appraisal factors (i.e., appraisal of illness/caregiving, uncertainty, hopelessness), coping resources (coping strategies, interpersonal relationships, self-efficacy), and quality of life domains (emotional, social, physical, and functional).This study also examines if patients’ risk for distress and other factors moderate the effect of the brief or extensive program on outcomes.

Aims

Aim One: Determine if family dyads randomly assigned to either a brief or extended family-based program of care (The FOCUS Program) have better proximal and distal patient and caregiver outcomes from both a clinical and economic perspective than dyads randomly assigned to usual care.

H1: Family dyads randomized to a brief or extended family-based program of care will report better proximal outcomes and distal outcomes than family dyads that receive usual care.

Proximal outcomes: less negative appraisal of illness or caregiving, less uncertainty, less hopelessness, more active coping, better family illness-communication, and higher self-efficacy. Distal outcomes: higher quality of life, greater satisfaction with care, and similar or lower health care resource utilization.

Aim Two: Determine if the brief or extended program of care has a differential effect on patient and caregiver outcomes depending on the patient’s risk for distress.

H2: There will be a differential effect of the family-based intervention on patients’ and caregivers’ proximal and distal outcomes, depending on the patient’s risk for distress (high versus low).

H2.1: Among dyads in which patients report high risk for distress: extended brief usual care.

H2.2: Among dyads in which patients report low risk for distress: extended or brief usual care.

Participants

Patients are eligible if they have been diagnosed with advanced breast, colorectal, lung or prostate cancer (i.e., Stage III or IV), and are within a six-month window of having a new advanced cancer diagnosis, progression of their advanced cancer, or change of treatment for it. Eligibility also includes a life expectancy six months, age 21 or older, living within 75 miles of participating cancer centers, and having a family caregiver willing to participate. Caregivers are eligible if they are age 18 or older and identified by patients as their primary caregiver (i.e., provider of emotional and/or physical care). Family caregivers are excluded if they have been diagnosed with cancer in the previous year or are receiving cancer treatment.